Kulkarni Aditya A, Chauhan Vivek, Sharma Vishal, Singh Harjeet
Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Cureus. 2019 Jun 24;11(6):e4987. doi: 10.7759/cureus.4987.
With an increasing number of long-term survivors of carcinoma esophagus, it is important to be vigilant about postoperative complications related to gastric tubes. Perforation of the gastric conduit has been rarely seen, with very few case reports in the literature. We report a rare case of perforation of the gastric tube conduit in a patient who had previously undergone esophagectomy for squamous cell carcinoma of esophagus five years ago. The patient presented with diffuse peritonitis in an emergency. On exploration, a large perforation was present on the anterior wall of the gastric conduit. This was closed with primary suture repair. Histopathology revealed nonspecific inflammatory changes. Unfortunately, the patient succumbed to severe sepsis and multiorgan dysfunction despite early surgical intervention and critical care management. Conduit perforation can be a major source of morbidity and mortality. Although gastric conduit is predisposed to ulcer formation due to multiple reasons, conduit perforation may occur only in rare cases. We recommend that surveillance endoscopy for conduit ulcer should be performed in long-term survivors after esophagectomy. Patients with conduit ulcers would benefit from long-term acid suppression with proton-pump inhibitors.
随着食管癌长期存活者数量的增加，警惕与胃管相关的术后并发症很重要。胃管穿孔很少见，文献中仅有极少的病例报告。我们报告一例罕见的胃管穿孔病例，该患者五年前因食管鳞状细胞癌接受了食管切除术。患者急诊时表现为弥漫性腹膜炎。探查发现胃管前壁有一个大穿孔。通过一期缝合修复进行了闭合。组织病理学显示非特异性炎症改变。不幸的是，尽管进行了早期手术干预和重症监护管理，患者仍死于严重脓毒症和多器官功能障碍。胃管穿孔可能是发病和死亡的主要原因。尽管由于多种原因胃管易形成溃疡，但胃管穿孔仅在极少数情况下发生。我们建议对食管切除术后的长期存活者进行胃管溃疡的监测性内镜检查。患有胃管溃疡的患者将从长期使用质子泵抑制剂抑制胃酸中获益。
